This guest post comes from Joan Obecny, a skilled nurse practitioner specializing in wound care from Olney, Maryland. She has been volunteering her skills for St. Boniface for the past 8 years, as a general nurse, as part of our mobile clinics, and with a visiting eye care team. She recently spearheaded development of several nurse education programs as well as the Risk Assessment/Wound Management Program at our Spinal Cord Injury Center.
Where prevention is a key component to any health promoting program, it is at the very core of every aspect of spinal cord injury care; learning to assess patient risk, implement measures to prevent complications and actively involve the SCI patient and caregiver in this process being the primary goal. Unfortunately, the potential risk to develop complications, particularly pressure related skin breakdown, i.e. pressure wounds, is high. These pressure wounds can develop overnight and then take months – even years to resolve.
The nurses working in the SCI Center at St Boniface Hospital have devoted an immense amount of time and effort over the past 15 months to learn and implement the specialized skin breakdown prevention and pressure wound treatment techniques required for their SCI patients. In addition to hours of classes and clinical hands on training, self study computer modules in the areas of risk assessment, pressure wound assessment and advanced pressure wound treatment have been developed and allow for a more individual learning style.
Drawing on their experience and training, as well as the nurse instructional tools, the first four nurses in the SCI Wound Program have now begun training auxiliary nursing staff. This creates a self sustaining skin breakdown prevention and pressure wound treatment program for the Center.
Tools to record and document risk assessment, wound assessment and wound treatment are now being used to track patient’s condition and progress. The SCI nurses are also educating patients and their caregivers, with the use of patient/caregiver instructional tools, the techniques and life style changes necessary to promote the ultimate goal of patient independent self care and living.
These nurse clinicians have become competent and confident in using advanced wound dressing products and state of the art wound treatments such as Negative Pressure Wound Therapy (NPWT). NPWT is a wound treatment which promotes rapid wound closure by improving blood flow and removing drainage from a wound. Numerous SCI patients with large, here to for, non closing pressure wounds, have benefited tremendously from this therapy with accelerated wound closure.
Great appreciation must be extended to those companies making treatment donations, without which the success of this program would not be possible. KCI (Kinetic Concepts, Inc.) donated 2 NPWT machines with dressing supplies; Molynke Pharmaceuticals donated advanced wound dressing products. These generous donations, and those of private donors, have enabled the St Boniface Hospital SCI Center to be one, of only a few locations in Haiti that provide these state of the art wound treatments.
With these new policies, procedures and equipment in place, the original four nurses and newly trained auxiliary nurses have attained a self perpetuating, self sustainable training and patient care program. The results allow for greater understanding in the prevention of skin breakdown on this high risk population, for faster and ultimately less costly pressure wound closure and for the enhancement of patient/caregiver independence in self – care and community reintegration.
The time invested and commitment made by these SCI nurse clinicians to learn and implement the interventions necessary to promote the optimum treatment and health of their SCI patients has been remarkable and truly inspiring to me. The work has been hard, but the rewards great as illustrated by the smiles of these dedicated SCI nurses.